1548200272 NPI number — CARE-A-VAN HOUSE CALLS PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548200272 NPI number — CARE-A-VAN HOUSE CALLS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE-A-VAN HOUSE CALLS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548200272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 BEECH TREE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KITTY HAWK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27949-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-441-9941
Provider Business Mailing Address Fax Number:
252-441-9943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 BEECH TREE TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KITTY HAWK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27949-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-441-9941
Provider Business Practice Location Address Fax Number:
252-441-9943
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PHILLIPS
Authorized Official First Name:
DELANA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
252-441-9941

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  9600229 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 891192E , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH7794 . This is a "MEDICARE 'B' RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 67565 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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